Organization
KMDT SERVICES LLC
Active
Other names
Signs of Change Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
KATHARINE HELENE MCHUGH LCSW (PRESIDENT)
(571) 279-8144
Entity
Organization
Contact information
Practice address
8420 DORSEY CIR, MANASSAS, VA 20110-8300
(571) 279-8144
Mailing address
7937 FLAGER CIR, MANASSAS, VA 20109-7437
(571) 279-8144
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0904007119
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945247
—
VA
01
—
020063P10
MEDICARE NUMBER
—
Enumeration date
11/12/2015
Last updated
11/12/2015
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